Clinical characteristics and treatment outcomes in pediatric microscopic colitis: A retrospective 13-year experience

Microscopic colitis (MC) is a histological inflammatory disease of the colon, commonly diagnosed in adults and known to be associated with autoimmune conditions. Clinical presentation and treatment outcomes in pediatrics are not well described. The aim of the current study was to describe pediatric MC cases encountered at a single center over a 13-year period.

We performed a retrospective chart review of patients aged 18 years and younger (inclusive) evaluated in our health system between 2013 and 2025 for MC.

Thirty-five patients (80% female) with an average age of 14.2 years at MC diagnosis were included. Presenting symptoms were chronic diarrhea, abdominal pain, and weight loss. Histologically, most patients had lymphocytic colitis (74%), and seven patients (20%) had concurrent celiac disease (CeD). At diagnosis, no patients had elevated systemic inflammatory markers and fecal calprotectin (tested in 26% of patients) was elevated in 66%. The most prescribed treatments included Budesonide (77%) and aminosalicylates (34%). Two patients required biologic therapy including Vedolizumab, Ustekinumab, and Adalimumab. A clinical subgroup emerged who showed complete symptomatic response to Budesonide without additional therapy (n = 8), and four patients in this group had CeD.

This study adds to the limited pediatric MC literature, including two cases requiring biologic therapy. Fecal calprotectin is presently underutilized but, when tested, was not reliably elevated in the active disease state. Like adults, Budesonide was the most prescribed therapy for pediatric MC and may represent an important first line treatment option due to select patients exhibiting complete symptomatic response.